Did You Know: That Smoking Cessation Interventions That Include Proactive Outreach May Help To Reduce Socioeconomic Disparities In Quitting?

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Population-based smoking-cessation services tend to preferentially benefit high-SES smokers, potentially exacerbating disparities. Interventions that include proactive outreach, telephone counseling, and free or low-cost cessation medications may be more likely to help low-SES smokers quit. A newly published study evaluated the role of SES in smokers’ response to a population-based proactive smoking-cessation intervention. Researchers analyzed data from the Veterans Victory Over Tobacco Study, a smoking-cessation intervention. Findings included that proactive outreach is associated with higher rates of prolonged abstinence among smokers at all SES levels. Proactive outreach interventions that integrate telephone-based care and facilitated cessation medication access have the potential to reduce socioeconomic disparities in quitting.
Source: Danan et al. (2018). The Equity Impact of Proactive Outreach to Smokers: Analysis of a Randomized Trial. American Journal of Preventive Medicine, Aug 20. pii: S0749-3797(18)31934-2. doi: 10.1016/j.amepre.2018.05.023. [Epub ahead of print]

Did You Know: That Higher SES is Linked To Higher Electronic Nicotine Delivery System Use?

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A newly published study investigated the association between socioeconomic status (SES) (education, income, and employment status) and current and former electronic nicotine delivery system (ENDS) use. Researchers analyzed data from the American Heart Association Tobacco Regulatory and Addiction Center (A-TRAC) online survey.

Findings included:

  • College educated persons (vs. those with less than a high school diploma) had a 37% greater prevalence of current ENDS use and a 16% greater prevalence of former ENDS use.
  • Persons with household incomes above $90K (vs. less than $20,000) had a greater prevalence of current and former ENDS use.
  • Those who were employed (vs. not employed) had a 13% greater prevalence of current ENDS use.
  • Higher SES (vs. lower SES) persons were more likely to use ENDS.
Source: Glover et al. (2018). The social patterning of electronic nicotine delivery system use among US adults. Preventive Medicine, Aug 29;116:27-31. doi: 10.1016/j.ypmed.2018.08.038. [Epub ahead of print]

Did You Know? Rural Women Lag Behind Rural Men, Urban Men And Urban Women In Decreasing Smoking

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Smoking prevalence is declining at a slower rate in rural than urban settings in the U.S. and known predictors of smoking do not readily account for this trend difference. A recently published study examined whether smoking trends are different for rural and urban men and women. Researchers analyzed data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas.


Findings included:

  • Whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat.
  • Controlling for demographic, socioeconomic and psychosocial predictors of smokingdid not explain rural women’s significantly different trend from those of the other three groups.


The researchers concluded that rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smokingamong rural women.

New Publication on Rural Health Equity from the National Academies of Sciences, Engineering, and Medicine
Achieving Rural Health Equity and Well-Being: Proceedings of a Workshop (2018)
Rural counties make up about 80 percent of the land area of the United States, but they contain less than 20 percent of the U.S. population. The relative sparseness of the population in rural areas is one of many factors that influence the health and well-being of rural Americans. Rural areas have histories, economies, and cultures that differ from those of cities and from one rural area to another. Understanding these differences is critical to taking steps to improve health and well-being in rural areas and to reduce health disparities among rural populations. To explore the impacts of economic, demographic, and social issues in rural communities and to learn about asset-based approaches to addressing the associated challenges, the National Academies of Sciences, Engineering, and Medicine held a workshop on June 13, 2017. This publication summarizes the presentations and discussions from the workshop.

Did You Know? Waterpipe Tobacco Smoking More Common Among Black And White Latinos Compared To Non-Hispanic Whites


A recently published study examined intra-ethnic racial differences in waterpipe tobacco smoking (WTS) among Latinos using a nationally representative sample. Researchers analyzed pooled data from the National Adult Tobacco Survey, 2012-2014.

 Findings included:

·         Black Latinos and White Latinos exhibited an increased prevalence of lifetime WTS compared to their non-Hispanic white counterparts.

·         Black Latino men exhibited increased prevalence of lifetime WTS compared to their non-Hispanic white men counterparts. 

·         Black Latinas and white Latinas exhibited increased prevalence of WTS compared to their non-Hispanic white women counterparts.

 The researchers concluded that among the U.S. general adult population, intra-ethnic racial differences in WTS behaviors exist among Latinos; and is shaped by gender. Future efforts to eliminate racial disparities in WTS should be attentive to intra-ethnic racial differences among Latinos.

Source: Ortiz et al. (2018). Intra-Ethnic Racial Differences in Waterpipe Tobacco Smoking among Latinos? Substance Use & Misuse, Jul 20, 1-10. [Epub ahead of print]

Did You Know? How to Tailor Technology-Based Cessation Programs for Socioeconomically Disadvantaged African American Smokers

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Communication technology-based interventions are increasingly being employed to help smokers quit. Understanding preferences for such strategies among socioeconomically disadvantaged smokers can inform targeted intervention planning. A newly published study examined socioeconomically disadvantaged smokers’ use of and access to communication technology and elucidated preferences for receiving quitting information and support via email and text message. A self-administered survey and focus groups were conducted with a sample of 15 predominantly African American, socioeconomically disadvantaged smokers aged 21-64 years.

Findings included:

·         Smartphone ownership was high, although use of communication-based cessation resources such as web sites and smartphone apps was low.

·         Four themes emerged relevant to preferences for receiving quitting information and support via email and text message: access, appropriateness, intended use, and satisfaction.

·         Although initially participants were mixed in their preferences for receiving emails vs texts, 80% preferred emails over texts when presented with sample emails and text messages containing cessation information.

The researchers concluded that although email and text message strategies may be acceptable to socioeconomically disadvantaged smokers generally, issues such as access and intended use should be considered to inform specific disparity-reducing intervention approaches.

Source: Alcaraz et al. (2018). To Text or Not to Text? Technology-based Cessation Communication Preferences among Urban, Socioeconomically Disadvantaged Smokers. Ethnicity & Disease, Jul 12, 28(3), 161-168.

Did You Know? Cigars, Cigarillos and Little Cigars Used Primarily By Male, Black Youth


A recently published study examined the association between risk perceptions of youths’ personal and parental attitudes toward smoking cigarettes, cigars, and marijuana with current use of cigars, cigarillos or little cigars (CCLCs) or modified CCLCs (i.e., freaking or blunting). Researchers analyzed data from the 2013 Cuyahoga County Youth Risk Behavior Survey.

Findings included:

  • 23.5% of youth reported current use of CCLCs in some way; 11.0% reported current freaking and 18.5% reported current blunt use.
  • CCLC users tended to be male and Black.
  • Perceiving all smoking behaviors as risky, wrong, or wrong by parents reduced odds of youth using CCLCs.
  • Blacks had increased odds of using CCLCs if they perceived smoking cigarettes as harmful, which was not found among other race/ethnicity categories.
  • Having parents who believed that smoking CCLCs is wrong increased the odds of youth freaking or blunting among all CCLC users.
  • Odds of blunting were greater for those who believed CCLCs were more risky among all CCLC users.

The findings suggest that CCLC users may think cigars are safer than cigarettes, and that modifiers may think their use is safer and more in line with their parents’ views than non-modified CCLCs.

Source: Trapl et al. (2018). Attitudes and Risk Perceptions Toward Smoking Among Adolescents Who Modify Cigar Products. Ethnicity & Disease, Jul 12, 28(3), 135-144.

Did You Know? Tobacco Use More Prevalent Among Bisexual Adults And Sexual Identity-Attraction Discordant Women

A newly published study examined tobacco use among U.S. adults and variations by age, race/ethnicity, and sexual identity-attraction concordance/discordance. Data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions were analyzed.
Findings included:
  • Tobacco use was more prevalent among sexual minority-identified adults compared with heterosexual-identified adults.
  • Tobacco use among sexual minorities was most prevalent among younger lesbian women and gay men, and all age groups of bisexual men and women.
  • Tobacco use was significantly greater among sexual identity-attraction discordant women and significantly lower among sexual identity-attraction discordant men.
The researchers concluded that self-identified bisexual adults and sexual identity-attraction discordant women appear to be at higher risk for adverse smoking-related health consequences as a result of their elevated rates of cigarette smoking.
Source: McCabe et al. (2018). Tobacco Use and Sexual Orientation in a National Cross-sectional Study: Age, Race/Ethnicity, and Sexual Identity-Attraction Differences. American Journal of Preventive Medicine, Apr 9. pii: S0749-3797(18)31636-2. doi: 10.1016/j.amepre.2018.03.009. [Epub ahead of print]

Did You Know? Study Highlights Smoking Patterns Among Adults Receiving Housing Assistance


A recently published study examined patterns of cigarette smoking (current, former, never) by sociodemographic, household, and chronic disease characteristics and correlates among US adults receiving housing assistance from the US Department of Housing and Urban Development (HUD) during 2007-2012. 

Findings included:

  • Overall, 48% of HUD-assisted adults were never smokers, 33% were current smokers, and 19% were former smokers.
  • The percentage of never smokers was significantly higher among adults aged 18 to 44 (54%) or 65 years or older (50%) than among adults aged 45 to 64 (38%).
  • The percentage of never smokers was significantly higher among women (51%) than men (41%).
  • The percentage of never smokers was significantly higher among Hispanic adults (59%) and non-Hispanic black adults (55%) than non-Hispanic white adults (37%)


Source: Wang et al. (2018). Characteristics and Correlates of Cigarette Smoking Status Among US Adults Receiving Federal Housing Assistance. Preventing Chronic Disease, Mar 22;15:E48. doi: 10.5888/pcd15.170395.


Did You Know? African American And Low SES Children With Asthma Have More Exposure To Passive Tobacco Smoke


A newly published study examined the risk of asthma in children exposed to passive tobacco smoke. Researchers analyzed National Health and Nutrition Examination Survey (NHANES) data collected from 2003 to 2014 (n = 8064).

Findings included:

  • The proportion of children living with household smokers decreased from 24.9% in the 2003-2004 cycle to 11.4% in the 2013-2014 cycle.
  • Highly exposed asthmatic children were primarily Non-Hispanic Black and whose family incomes were below poverty guidelines.
  • Overall results reveal passive smoke exposure level among children ages 3-11 in the US decreased over the study period.
  • Nevertheless, higher exposure to passive smoke is still associated with higher odds of childhood asthma.

 The researchers concluded that targeted smoking cessation interventions in clinical practices are needed to reduce tobacco smoke exposure and related asthma risk in children, particularly in low-income and minority groups.


Source: Zhang et al. (2018). Decreasing trend in passive tobacco smoke exposure and association with asthma in U.S. children. Environmental Research, May 31;166:35-41. doi: 10.1016/j.envres.2018.05.022. [Epub ahead of print]

Did You Know? Smoking Cessation Could Improve HIV Outcomes For Sexual Minority Men With HIV

Cigarette smoking is particularly harmful for sexual minority men living with HIV. A newly published study examined the benefits of quitting by examining relationships between smoking and sustained HIV RNA suppression, recent CD4 count, ART medication adherence, and engagement in HIV medical care. Sexual minority men (n = 346), former or current smokers, received HIV care at a community health center. Most patients were Caucasian (87%), 148 (46%) had incomes below the poverty level and 80% had sustained HIV RNA suppression. Compared to current smokers, former smokers had increased odds of sustaining HIV RNA suppression, of reporting > 90% treatment adherence, and were less likely to miss appointments. Heavier smokers and patients who smoked the longest had reduced odds of sustaining HIV RNA suppression. The researchers concluded that smoking assessment, treatment, and referral could augment HIV outcomes for sexual minority men with HIV.
Source: King et al. (2018). Treatment Outcomes Associated with Quitting Cigarettes Among Sexual Minority Men Living with HIV: Antiretroviral Adherence, Engagement in Care, and Sustained HIV RNA Suppression. AIDS and Behavior, Apr 21. doi: 10.1007/s10461-018-2116-3. [Epub ahead of print]



That Tobacco Cessation Programs May Want To Target Low SES Sexual Minorities Within A Context Of Co-Occurring Substance And Alcohol Use?

Cigarette smoking is substantially more prevalent and rates of smoking cessation are lower in low-SES adults. Financial strain may be one explanation for this. A newly published study assessed the link between financial strain, quit attempts, and successful smoking cessation among adult smokers in the U.S. Data from the Population Assessment of Tobacco and Health Study (2013-2015) were analyzed.

Findings included:

  • Smokers with financial strain made more quit attempts than smokers without financial strain, but financial strain was not associated with abstinence at follow-up.
  • Low income was associated with less abstinence at follow-up.
  • Smokers with baseline financial strain who quit at follow-up had lower odds of financial strain at follow-up.

The researchers concluded that financially strained smokers made slightly more quit attempts than non-strained smokers but were no more likely to successfully quit.

Source: Kalkhoran et al. (2018). Financial Strain, Quit Attempts, and Smoking Abstinence Among U.S. Adult Smokers. American Journal of Preventive Medicine, Apr 5. pii: S0749-3797(18)30068-0. doi: 10.1016/j.amepre.2018.01.036. [Epub ahead of print]

Read the abstract at: https://www.ncbi.nlm.nih.gov/pubmed/29628382

Did You Know? Black-Latinos Are More Likely To Smoke Menthol Cigarettes Compared to White-Latinos

Using data from the National Adult Tobacco Survey (NATS), a newly published study examined the relationship between race and smoking behaviors among Latinos/Hispanics. The study sample included 505 Black-Latinos and 9078 White-Latinos. While no racial differences were found in lifetime smoking status among Latinos, Black-Latinos had a 17% increased risk of menthol smoking compared to White-Latinos. The researchers concluded that menthol consumption is influenced by race among Hispanics/Latinos. In order to address racial disparities among Latinos/Hispanics, further attention needs to be given to racial differences in smoking-related risks among Latinos/Hispanics.
Source: Cuevas et al. (2018). Assessing racial differences in lifetime and current smoking status & menthol consumption among Latinos in a nationally representative sample. Ethnicity & HealthMar 14:1-17. doi: 10.1080/13557858.2018.1447651. [Epub ahead of print]
Read Abstract here